| NPI | 1366239675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 055341) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 014359-01) |
| Enumeration Date | 2025-04-21 |
| Last Update Date | 2025-12-01 |